Is There Agreement between Hospitalized Patients' Confidence and Actual Ability to Use Respiratory Inhalers?

1University of Chicago Medical Center, Chicago, IL
2University of Chicago Medical Center, Chicago, IL
3University of Chicago Medical Center, Chicago, IL
4University of Chicago Medical Center, Chicago, IL
5University of Chicago Medical Center, Chicago, IL
6University of Chicago Medical Center, Chicago, IL
7University of Chicago Medical Center, Chicago, IL
8University of Chicago Medical Center, Chicago, IL
9University of Chicago Medical Center, Chicago, IL

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 114

Background:

Inhalers are often used incorrectly by patients. Therefore, guidelines recommend evaluation of patient comprehension and education of respiratory inhaler use at all points of care, including hospitals. Determining ways to target use of instruction methods is important in resource‐limited environments, For instance, if patients are able to accurately self‐identify their need for instruction, this could be quickly assessed with a simple question. The objective of this ongoing pilot study was to evaluate the agreement between a patient's confidence in their ability to use respiratory inhalers correctly and the effectiveness of inhaler technique.

Methods:

Adults (≥ 18) hospitalized with a history of asthma or COPD were enrolled. Patient demographics were obtained. To identify high‐risk patients, information regarding near‐fatal events (defined as ever having an ICU admission or intubation) was obtained, To assess patients' confidence in their ability to use respiratory inhalers, patients were asked about the following statement for both MDI and Diskus© devices: “l am confident that I know how to use this respiratory inhaler correctly.” Patients answered using a 5‐point Likert scale, from 1 = strongly disagree to 5 = strongly agree. Those answering agree (4) or strongly agree (5) were dichotomized as “confident”; all others (1‐3) were labeled “not confident.” Patients' ability to use metered‐dose‐inhalers (MDIs) and Diskus© inhalers were assessed using detailed standardized checklists. Patients' technique was dichotomized into adequate (>75% of steps correct) or inadequate (≤75% correct) for each device. Mastery was defined as a perfect score. Kappa statistics were calculated using Stata 10.

Results:

Preliminary analyses from this ongoing study (July 2009–present, n = 15 to date) demonstrate the majority were African American (80%), female (73%), and < 65 years of age (93%). Almost half (47%) had a near‐fatal event Only 1 patient (7%) demonstrated mastery, and only 27% had adequate technique for MDIs, although 67% said they were confident. There was almost no agreement between mastery and confidence (k = 0.07, P = 0.23) and only fair agreement between adequate technique and confidence (k = 0.31, P = 0.049) for MDIs. For those using Diskus® (n = 10), only 10% demonstrated mastery and 20% had adequate technique, whereas 90% were confident about their inhaler use, However, there was almost no agreement of mastery or adequate technique with confidence (k = 0.02, P = 0.36; k = 0.05, P = 0.3, respectively).

Conclusions:

In this population enriched with high‐risk patients, there was almost no agreement between actual ability and confidence with using inhalers, except for fair agreement for adequate MDI technique. If this finding is confirmed in our larger sample, simply asking patients to self‐report a need for inhaler technique education may be insufficient to identify patients in need of instruction. Further studies are needed to identify targeted methods of effective inhaler education in resource‐limited environments.

Author Disclosure:

V. Press, none; L. Shah, none; S. Lewis, none; K. Ivy, none; A. Mazurek, none; J. Charbeneau, none; J. Starkey, none; E. Naureckas, none; J. Krishnan, none.

To cite this abstract:

Press V, Shah L, Lewis S, Ivy K, Charbeneau J, Mazurek A, Starkey J, Naureckas E, Krishnan J. Is There Agreement between Hospitalized Patients' Confidence and Actual Ability to Use Respiratory Inhalers?. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 114. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/is-there-agreement-between-hospitalized-patients-confidence-and-actual-ability-to-use-respiratory-inhalers/. Accessed May 26, 2019.

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